Q. A young male presents to the ED with two large, swollen red bumps — one on each upper forearm. The bump on the right has a white/yellow tip and has begun to leak. The bump on the left does not seem to be leaking, but is very red and producing a lot of heat. The doctors referred to it as “bilateral cellulitis”. What is bilateral cellulitis, how can it be treated, and what was the liquid leaking out of the right forearm?
A. Cellulitis is a potentially serious deep skin infection that manifests itself in the form of a swollen, red area of skin that feels hot and tender. While it is not usually spread from person to person, it can spread rapidly to other parts of the body if left untreated. Bilateral referred to the nature of the infection — that it existed on both arms. In the case that I saw, the doctors were able to determine from the patient’s direct testimony and the locations of cellulitis that the infection was due to the use of dirty needles when injecting heroin. The swollen bump on the left was cellulitis in its’ purest form — however, the bump on the right that had already begun leaking was a case of an “abscess”, a complication that can arise from cellulitis being untreated. An abscess is a painful collection of pus, usually caused by a bacterial infection and can be treated with antibiotics, a drainage procedure, or surgery. In this patient’s case, the abscess was too large to heal on its own with the use of antibiotics — it had to be drained with surgery. A local anesthetic was applied until the area around the abscess was numbed, and the surgeon used a scalpel to make a small incision. Following incision, gauze was held to the incision site until all the blood and pus from inside the abscess had drained. An antiseptic dressing was then placed inside the wound to keep it open, and a wound dressing placed on top to collect any additional pus that drained out. The arm was then wrapped up and the patient was told to stay in the ER overnight for observation. The abscess we saw was not large enough to warrant internal debridement — if the cavity had been larger, then a sterile saline solution would have been used to further clean the hole. In addition to the procedure, the patient was prescribed oral antibiotics to further treat the abscess and the cellulitis on the left arm (which had not yet become an abscess). Resources: